When making a claim for long term disability benefits, I recommend that the claim be done as soon as possible. There are timelines within your policy of insurance, which require you to provide an application or proof of loss within a specified timeframe. Although these timelines are not like that of a limitation period, missing time periods can result in an insurer denying your claim.
When making a claim for long term disability benefits, I recommend that the claim be done as soon as possible. There are timelines within your policy of insurance, which require you to provide an application or proof of loss within a specified timeframe. Although these timelines are not like that of a limitation period, missing time periods can result in an insurer denying your claim. When an insurer denies a claim based on missing a time-period prescribed by law, you may seek what is called relief from forfeiture. A relief from forfeiture allows the court, at its discretion, to protect a person from losing a right or interest in an agreement or contract due to a failure to perform a condition (applying for a benefit within a certain timeframe) of the contract. It is a purely discretionary power of the court and the facts will determine the outcome.
Although courts are prepared to grant relief, it is not always a given that this will occur given the court’s discretion. In Wiles v. Sun Life Assurance Company of Canada, 2018 ONSC 1090 (CanLii) (upheld by the Ontario Court of Appeal (Wiles v. Sun Life Assurance Company of Canada, 2018 ONCA 766) the court reviewed the Supreme Court of Canada case, Saskatchewan River Bungalows Ltd. V. Maritime Life Assurance Co., 1994 CanLII 100 (SCC) regarding the test for the test for relief against forfeiture. The relief is discretionary and based on three considerations: a) the conduct of the applicant; b) the gravity of the breach; c) the disparity between the value of the property forfeited and the damages caused by the breach.
In denying the claim, the court held that the gravity of the plaintiff’s failure to comply with the notice provisions of the Sun Life policy was significant. As well, the court noted that there was no evidence presented that would demonstrate any significant disparity between the value of the LTD benefits forfeited and the damage caused by the breach.
To avoid an insurer denying your claim for missing a deadline and the possibility that you will not receive relief from forfeiture, the following steps must be taken:
- KNOW YOUR POLICY! Make sure that you are aware of the timelines contained within the policy. Know the difference between the elimination period and the proof of loss period. Read the policy on long-term disability benefits. Do not assume that someone else will do it for you. Consult a lawyer immediately if you need advice.
- REQUEST A COPY OF THE DISABILITY FORMS. Do not simply wait for someone to send you the forms. Take proactive steps to talk to your human resources department or obtain the documents online.
- SUBMIT THE INFORMATION REQUIRED. Do not delay in providing medical or other documentation required. Move quickly to obtain the documentation and make sure that you let the insurer know what steps you are taking.
- DO NOT IGNORE REQUESTS FOR INFORMATION. If your insurer requires information, provide it. If you refuse to provide the information, then you may put your claim in jeopardy. If you believe that the information requested is not relevant, then immediately seek the advice of a lawyer.
If you or a loved one has been wrongfully denied a long-term disability benefit, please call me to discuss your matter and what can be done to help.